瑞马唑仑联合舒芬太尼抑制无痛人工流产术扩张宫颈体动研究  

Research of Remazolam Combined with Sufentanil in Hibiting the Responses of Cervical Dilation During Painless Abortion

作　　者：陈秋红[1] 刘博文 杨文明 胥露露 CHEN Qiuhong;LIU Bowen;YANG Wenming;XU Lulu(The First Affiliated Hospital of Nanchang University,Nanchang Jiangxi 330006,China)

机构地区：[1]南昌大学第一附属医院,江西南昌330006

出　　处：《药品评价》2022年第11期697-701,共5页Drug Evaluation

基　　金：江西省重点研发计划项目(20203BBGL73212)。

摘　　要：目的:测定无痛人工流产术麻醉诱导时瑞马唑仑联合舒芬太尼抑制扩张宫颈体动的半数有效剂量(ED)。方法:择期行无痛人工流产术患者53例,分为无分娩史患者组(N1组,n=29)和有自然分娩史患者组(N2组,n=24)。根据改良Dixon序贯法,所有患者先予舒芬太尼0.1μg/kg预处理,随后静脉注射瑞马唑仑0.2 mg/kg,2 min后开始手术,若患者在扩张宫颈时出现体动为阳性反应,下一例患者瑞马唑仑剂量增加0.05 mg/kg,否则降低0.05 mg/kg,当出现8次折返终止试验。采用概率单位回归分析法(Probit法)计算两组瑞马唑仑的ED和95%可信区间(95%CI)。观察和记录所有患者入室时(T0)、麻醉诱导后2 min(T1)、扩张宫颈结束时(T2)及手术结束时(T3)各时间点的血流动力学和Ramsay镇静评分等指标,记录相关不良反应发生情况。结果:无分娩史患者瑞马唑仑的ED为0.21 mg/kg,95%CI 0.17~0.25 mg/kg;有自然分娩史患者瑞马唑仑的ED为0.14 mg/kg,95%CI 0.11~0.17 mg/kg。同组内有体动反应患者T1时刻Ramsay镇静评分均明显低于无体动反应患者(P<0.01);所有患者血流动力学指标均在安全范围内波动。结论:瑞马唑仑联合舒芬太尼用于无痛人工流产术麻醉安全有效,且有分娩史患者瑞马唑仑的ED50低于无生育史患者。Objective:To determine the 50%effective dose(ED)of remazolam combined with sufentanil to inhibit cervical dilation in painless abortion at the anesthesia induction.Methods:Fifty-three patients were selected to receive painless induced abortion and were divided into patients with no history of delivery(N1 group,29 cases)and patients with a history of delivery(N2 group,24 cases).According to the modified Dixon sequential test method,all patients were pretreated with sufentanil 0.1μg/kg,followed by intravenous injection of remazolam 0.2 mg/kg,and the operation was started 2 minutes later.If the patient had a positive response to body movement during cervical dilation,the dose of remazolam was increased by 0.05 mg/kg for the next patient,otherwise it was decreased by 0.05 mg/kg.The study was terminated when 8 reentrance were observed.Probit regression analysis was used to calculate the EDand 95%confidence interval(95%CI)of remazolam in the two groups.The hemodynamics and Ramsay sedation scores were observed and recorded for all patients at each time point at the time of admission(T0),2 minutes after induction of anesthesia(T1),at the end of cervical dilation(T2),and at the end of surgery(T3),and the occurrence of related adverse reactions was recorded.Results:The EDof remazolam in patients without a history of delivery was 0.21 mg/kg,95%CI 0.17-0.25 mg/kg;the EDof remazolam in patients with a history of delivery was 0.14 mg/kg,95%CI 0.11-0.17 mg/kg.The Ramsay sedation score at T1 time of all patients with body movement response was significantly lower than that of patients without body movement response(P<0.01).All patients’hemodynamic parameters fluctuated within a safe range.Conclusion:Remazolam is safe and effective for anesthesia in painless abortion when combined with sufentanil,and the ED50 of remazolam in patients with a history of delivery is lower than that patients without a history of delivery.

关 键 词：麻醉 静脉 流产 人工 瑞马唑仑 舒芬太尼 半数有效剂量 分娩史 

分 类 号：R614[医药卫生—麻醉学]